DEVELOPMENT AND MAINTENANCE OF

STANDARDS
• Introduction to Quality Assurance and Accreditation
• Quality Assurance
• Quality Improvement
• Standards
• Accreditation
• Various Professional Agencies ICN, INC, BFUHS, PNRC

INTRODUCTION TO QUALITY ASSURANCE AND ACCREDITATION

In nursing education, the quality is expected to be the extent to which nurses are to be prepared as the
profession desires. Quality is subjective and is based on an individual's background, perspectives and
standards. The National League for Nursing Accrediting Commission, USA in its Accreditation manual
defines Quality as ensuring high levels of students learning and achievement. The Department of
Health, UK views Quality as that the nurse graduates are competent and worthy of a licence to practise
nursing and meet the satisfaction level of the nursing clients

According to Dr Prakin Suchaxaya, Quality can be defined in various ways based on interpretation
• Technical interpretation: a specific characteristic of an object, its properties
• Philosophical interpretation : the essence of an object
• Practical interpretation: achievement or excellence
• Metaphysical interpretation: the meaning of excellence itself.
• Scientific interpretation: something to be desired.

UNESCO (2007) published an article on 'Quality Assurance and Accreditation: a glossary of

basic terms and definitions. It included various definitions related to quality assurance and
accreditation. Let us understand the difference between all these terms as explained by
UNESCO-CEPES to prevent confusion and ambiguity.
Institutional Accreditation: The terms refer to the accreditation of an en tire institution,
including all its programmes, sites, and methods of delivery, without any implication to the quality of
the study programmes of the institution.

Benchmark: A standard, a reference point, or a criterion against which the quality of something
can be measured, judged, and evaluated, and against which outcomes of a specified activity can be
measured. The term, benchmark, means a measure of best practice performance.

Certification: The process by which an agency or an association acknowledges the

achievement of estalished quality standards and usually grants certain privileges to the
target individual (student or teacher).

Criteria: Checkpoints or benchmarks determining the attainment of certain objectives and/or

standards. Criteria describe to a certain degree of detail the characteristics of the requirements and
conditions to be met (in order to meet a standard) and therefore provide the (quantitative and
qualitative) basis on which an evaluative conclusion is drawn.
Evaluation: The general process of a systematic and critical analysis leading to judgments and
recommendations regarding the quality of a higher education institution or a program. An evaluation is
carried out through internal or external procedures.
Indicators: Operational variables referring to specific, empirically measurable characteristics
of higher education institutions or programs on which evidence can be collected that allows for a
determination of whether or not standards are being met.
Outcomes: Anticipated or achieved results of programs or the accomplishment of
institutional objectives, as demonstrated by a wide range of indicators (such as student
knowledge, cognitive skills, and attitudes). Outcome sare direct results of the instructional program,
planned in terms of learner growth in all areas. An outcome must be distinguished from an objective,
which is a desired result.
Student Learning Outcomes: Statements of what a learner is expected to know, understand,
and be able to demonstrate after completion of a process of learning as well as the specific intellectual
and practical skills gained and demonstrated by the successful completion of a unit, course, or
program.
Peer review/external review: Assessment procedure regarding the quality and effectiveness of
the academic programs of an institution, its staffing, and/o r its structure, carried out by external experts
(peers)
Quality (academic) Quality in higher education is a multi-dimensional, multi-level, and
dynamic concept that relates to the contextual settings of an educational model, to the institutional
mission and objectives, as well as to specific standards within a given system, institution, program, or
discipline.
Quality Assurance: An all embracing term referring to an ongoing, continuous process of
evaluating (assessing, monitoring, guaranteeing, maintaining, and imp roving) the quality of a higher
education system, institutions, or programs.
Quality Control: The process of quality evaluation that focuses on the internal measurement of
the quality of an institution or a program. It refers to a set of operational activities and techniques
(monitoring activities and a structured internally planned and implemented policy) elaborated and used
to fulfill requirements of quality.
Quality Management: An aggregate of measures taken regularly at system or institutional level
in order to assure the quality of higher education with an emphasis on improving quality as a
whole.
Quality Audit: The process of quality assessment by which an external body ensures that (i)
the institution of program quality assurance procedures or (ii) that the overall (internal and
external) quality assurance procedures of the system are adequate and are actually being carried
out
Recognition: Formal acknowledgement of (i) individual academic or professional
qualifications; (ii) programs of a higher education institution; and/or (iii) quality assurance age
ncies, by a competent recognition authority that acknowledges certain standards and values with
respect to special purposes that indicate the consequences of recognition. Recognition is usually of a
cross-institutional or cross-border nature.
Standards: Statements regarding an expected level of requirements and conditions against which
quality is assessed or that must be attained by higher education institutions and their programs in
order for them to be accredited or certified . The term standard means both fixed criteria (against
which an outcome can be matched) and a level of attainment.
Validation: The process by which a program is judged to have met the requirements for an
award by a relevant institution with degree awarding powers (institutional self evaluation) or by a
relevant examining board (validation by an outside examining body).
The pursuit of quality is a continuous cycle, which involves the development of standards, quality audit,
and quality assessment, qua lit y assurance, quality improvement and accreditation
 QUALITY A S S U R A N C E

Education aims to bring out behavior change in an individual to prepare him/her to function
properly in society according to societal needs. Quality assurance (QA) is one of the mechanism
developed by educational institutions to ensure that graduates attain adequate standards of education
and training. It-may consist of Internal and external QA. Nursing education is a professional education
that constitutes education at the tertiary level. The instruction al obligation is highly crucial in
producing quality nursing to respond to societal demand. The field of quality assurance is as old as
modem nursing. Florence --Nightingale introd uced the concept of quality in nursing care in 1855,
while attending the soldiers in the hospital during the Cri mean war. It is a matter of pride for nurses
that the nursing profession has attained a distinct position in the search for quality in health care.
Nursing is a profession and discipline deeply rooted humanist, whose essence is the care of people.
Its foundations give support to a practice, profound humanism, which has evolved with scientific
and technical progress. In keeping with its purpose to improve, exercises the power that tends to
quality assurance systems in health services, seeking to satisfy the needs of society. Thus, quality
has become an essential element of health services considering the fundamental requirement for
the training of nursing professionals.

DEFINITIONS OF QUALITY ASSURANCE

 Quality Assurance: It is a systematic, ongoing and continuous vi analysis and

evaluation of the level of compliance with the standards set at local, national and international.
 Quality Assurance is a regulatory mechanism focusing on both accountability and
improvement, providing information and judgments (not ranking) through an agreed upon
and consistent process and well established criteria.
 Quality assurance is a dynamic process through which nurses assume accountability for the
quality of care they provide. It is a guarantee to society that services provided by nurses are
being regulated by members of the profession.
 Quality assurance is a judgment concerning the process of care, based on the extents to which
that care contributes to valued outcomes.
 Bull (1985) defined quality assurance as the monitoring of the activities of" client care
to determine the degree of excellence attained to the implementation of the activities.
 According to Stellar (1992), Quality assurance has been defined as a process of evaluation that
is applied to the healthcare system and provision of health care services by register nurse (RNs)'
 According to Marker (1998), 'Quality assurance is the defining of nursing practice through well
written nursing standards of the use of those standard s as a basis for evaluation on improvement
of client care' According to the JCAHO,' Quality Assurance is a planned and systematic process?
For the monitoring and evaluation of the quality and appropriateness of client care and for
resolving identified problems.
 According to, The Commonwealth of Learning (COL), Quality Assurance is a process through
which education institution guarantees to itself and its stake holders that its teaching, learning and
other services consistently reach a level of excellence.

 According to Frazer, 1992, Quality Assurance can be defined in terms of its four
components:
- Everyone in the enterprise has a responsibility for enhancing the quality
of the product or ser- vice;
- Everyone in the enterprise has a responsibility for maintaining the quality of
the product or service;
- Everyone in the enterprise understands, uses and feels ownership of the systems which
are in place for maintaining and enhancing quality; and Management regularly checks the
validity of the system for checking the quality.
 NEED OF QUALITY ASSURANCE IN NURSING EDUCATION
In the era of quality orientation, human rights and a consumer-driven society the quest is for the
best quality of education. The Nursing and Midwifery Education Institutions (NMEI) are expected to
provide quality instruction, and perform their roles effectively in producing qualified graduates who
will satisfy the demands and expectations of society. The following factors will assist us to realize the
need for quality assurance in nursing education:
• Competition: There is a drastic increase in the number of nursing schools and colleges in India.
This mushrooming has led to deteriorating quality of education provided to student nurses and
competition among educational institutions for students and funds. Moreover, with globalization,
the educational environment will be seized by increased competition. In order to survive in such a
situation, educational institutions need to imp rove their quality.
• Client satisfaction: Students, parents or sponsoring agencies as customers of the educational
establishments are nowadays highly conscious of their rights or finding value for their money and
time expended. They are now demanding good quality teaching and receiving employable skill
sets. Educational institutes should constantly improve quality of nursing education provided to
students to meet the increasing demand of parents and pupils.

• Maintaining standards: Standards are formally documented- req uirements and specification s against
which performance can be measured. In order to maintain the standard, an educational institution
should consciously make effort s to improve quality of the educational transactions as well as the
educational provisions and facilities.

• Accountability: Every institution is accountable stakeholders in terms of the hinds (public or

private) used to it. Care for quality will guarantee accountability of the funds utilized and inform
the stakeholders about taking appropriate decisions. Hence, quality can be thought as a monitoring
mechanism.

• Improve employee morale and motivation: Quality control and assurance in educational
institutions will imp rove the morale and motivation of the staff in performing their duties and
obligations. If a quality scheme is in space, the internal procedures would be systematic making every
department complementing each other's service domain. It will help in developing internal customer
satisfaction leading to high morale and motivation

• Credibility, prestige and status: Maintenance or quality assurance will bring credibility to individuals
and institutions because of consistency of services provided. It will further lead to prestige, status and
brand value.

• Image and visibility: Quality institutions have the capacity to attract better stake holder
support, like getting merited students from far and near, increased donations/ grants from
philanthropists/ funding agencies and higher employer interest for easy placement of graduates.

APPROACHES FOR A QUALITY ASSURANCE PROGRAMME

Two major categories of app roaches exist in quality assurance, they are, general approach and
specific approach.
- Genera l approach:
- It involves large governing of official body's evaluation of a person's or agency’s ability to
meet established criteria or standards at a given time.
 o Credentialilling: It is generally defined as the for- mal recognition of professional or
technical competence and attainment of minimum standards by a person or agency.
According to Hinsvack (1981) credentialing process has four hinctional components:
To produce a quality product To confer a unique identity
To protect provider and public To control the profess ion.

- Licensure: Individual licensure is a contact between the profession and the state, in which the
profession is granted control over entry into and exit from the profession and other quality
of professional practice. The licensing process requires that regulation be written to define the
scopes and limits of the professional practice. The licensure of nurses has been mandated by
the law since 1903.

- Accreditation: national League for Nursing (NLN), a voluntary organisation, has established
standards for inspecting nursing education programmes. In accreditation process agency's
physical structure, organisational structural and personal qualifications are evaluated. In 1990,
more emphasis was placed on evaluation of the outcomes of care and on the educational
qualification of the person providing care.

- Certification: Certification is usually a voluntary process within the profession. A person's

educational achievement, experience and performance on examination are used to determine a
person's qualifications for functioning in an identified specialty area.

-
- Specific approaches:
Quality assurances are methods used to evaluate identified instances of provider and client
interaction.
Peer review committee: These are designed to monitor client specific aspects of care appropriate for
certain levels of care. The audit has been the major tool used by a peer review committee to ascertain
quality of care.
Utilisation review (U R): Utilisation review activities are directed toward assuring that care is
actually needed and that the cost appropriate for the level of care provided.

Three types of utilization review are: Prospective: It is an assessment of the necessity of care
before giving services.
Concurrent: A review of the necessity of care, while the care is being given.
Retrospective: In the analysis of the necessity of the services received by the client after the
care has been given. UR has been used primarily in hospital to establish need for client ad
mission and the length of hospital stay. The UR process includes the development of exp
licit criteria that serves as indicators of the need for services and length of services.

ADVANTAGES OF UTILISATION REVIEW:

 It is designed to assist client to avoid unnecessary care.
 It may serve to encourage the consideration of care option by providers
such as home healthcare rather than hospitalization.
 It can provide guidelines for staff program development.
 It provides a measure of agency account- ability to the consumer.
EVALUATION STUDIES :

Three major models have been used to evaluate quality care they are:

- Donabedian's structure-process-outcome model.

- The tracer model.
- The sentinel model.

DONABEDIAN'S STRUCTURE-PROCESS-OUTCOME MODEL Donabedian introduced 3 major method

of evaluating quality care.

• Structural evaluation: This method evaluates the setting and instruments used to provide care
such as facilities, equipment, characteristics of the administrative organisation and qualification of
the health providers. The data for structural evaluation can be obtained from the existing
documents of an agency from an inspector of facilities.
• Process evaluation: This method evaluates activities as they relate to standards and expectations
of health providers in the management of client care. Data for this can be collected through
direct observation of providers, encounters and review of records audit, checklist approach
and the criteria mapping approach establish the client encounter protocol.
• Outcome evaluation: Outcome evaluation includes the net changes that occur as a result of health
care or the net result of healthcare. The data of this method can be collected from vital statistical
records such as death certificates, in person or telephone client interviews, mailed questionnaire and
client records.

TRACER METHOD:

It is a measure of both process and outcome of care. In tracer method; one must identify the value of
a client with a particular characteristic resuming specific healthcare management. Physician and
nurse practitioners identify persons with certain illness such as HT, ulcer, UTI, and establish criteria
for good medical and nursing management of illness. This method provides nurses with data to show
the difference in outcome as a result of nursing care standards.

SENTINEL METHOD:
• It is an outcome measure for examining specific instance s of client care. The characteristics
of this method are
• Cases of unnecessary diseases, disability, death are counted.
• The circumstances surrounding the unnecessary event or the sentinel are
examined in detail.
• A review of morbidity and mortality are used as an index.
• Health status indicators such as changes in social, economic, political and
environmental factors are reviewed which may have an effect on health outcomes.

Client satisfaction can be assessed by using personal or telephone interviews and mailed
questionnaire data from client satisfaction surveys to measure the structure, process and
outcome of caregiver. Risk management activities are directed towards the identification,
analysis and evaluation of situations to prevent injury and subsequent financial loss.
Malpractice litigation is a specific approach to be imposed in the healthcare delivery system
by the legal system. Malpractice litigation results from client dissatisfaction with the provider
and with the content of the care received.
 According to Indian Nursing Council, key components of quality assurance are:-
• Planning for quality,
• Developing strategies, standards, criteria, indicators and
• Ensuring their compliance by the nursing institutions.
The result from development of the model for instructional quality assurance in nursing science
(Fig. 15.1).

QAS refers systems management of the daily practices in the nursing institutions in order to
ensure that the institution runs the nursing programs according to the standards defined by the
national organization The quality of the program must develop and improve continuously
in order to ensure that clients being cared for by nurses/midwives who have graduated from
accredited institutions are safe.

Nursing and Midwifery Educational Institutions (NMEI) should establish their own QAS and develop
effective teaching processes of that hey produce qualified nursing and midwifery graduates who are
able to effectively provide care of the best quality. Fig 15.2 depicts Framework for improving the
quality of a Nursing and Midwifery Educational Institutions (NMEI) by WHO (Fig. 15.2).

QUALITY IMPROVEMENT

Quality improvement is the continuous study and imprm1ement of the processes and outcomes of
providing healthcare services to meet the needs of patients by examining the systems, and processes of
how care and services are delivered.

J C AHO's ten steps for quality improvement are as following:

• Establish responsibility and accountability for a QA program.

Fig. 15.2: Framework
Define theforscope
improving quality of
inaaNursing
clinicaland Midwifery Educational Institutions (NMEI)
• of services area.
 • Define the key aspects of services for the clinical areas.

• Develop quality indicators to. Monitor the outcomes and appropriateness of care
de li v er e d .
• Establish threshold for evaluation of indicators.
• Collect and analyze data from monitoring activities.
• Evaluate results of monitoring activities to determine the need for change in practice.
• Resolve problems through the development of action plans
• Re-evaluate to determine, if the action plan was successful.
• Communicate results of QI to members of the organization.

FACTORS AFFECTING QUALITY ASSURANCE IN NURSING CARE:

o Lack of resources: In sufficient resources, infrastructure, equipment, consumables, money

for recurring expenses and staff make it possible for the output of a certain quality to be
turned out under the prevailing circumstances.
o Personnel problems: Lack of trained, skilled and motivated employees, staff indiscipline
affects the quality of care.
o Improper maintenance: Building and equipment require proper maintenance for efficient
use. If not maintained properly, the equipment cannot be used in giving nursing care.
• Unreasonable patients and attendants: Illness, anxiety, absence of immediate response to
treatment, unreasonable and uncooperative attitude that in turn affects the quality of
care in nursing.
• Absence of well informed population: To improve the quality of nursing care, it is
necessary that the people become knowledgeable and assert their rights to quality
care. This can be achieved through continuous educational programs.
• Absence of accreditation law: There is no organization empowered by legislation to lay
down standards in nursing and medical care so as to regulate the quality of care. It
requires a legislation that provides for the setting of a stationary accreditation and
vigilance authority to
 Inspect hospitals and ensure that basic requirements are met.
 Take action against health professionals involved in malpractice.
 Inquire into major incidents of negligence
Lack of incident review procedure: These critical incidents may occur in hospitals:

 Delayed attended by nurses, surgeon, and physician.

 Incorrect medication.
 Bum s arising out of a faulty procedure.
 Death in a co rridor with no nurse and physician to accompany patient.
• Lack of good hospital information system: A good management information system is
essential for the appraisal of the quality of care.
• Absence of patient satisfaction survey: Ascertaining of patient satisfaction
at fixed points on an ongoing basis. Such surveys carried out through.
questionnaires, interviews by social workers , consultant groups, help to
document patient satisfaction with respect to variable. Nursing care records
are perhaps the most useful source of information on the quality of care.
Lack of nursing care records can hamper measurement of quality.
• Miscellaneous factors
• Lack of good supervision.
• Absence of knowledge about philosophy of nursing care.
 • Lack of policy and administrative manuals.
• Substandard education and training. Lack of evaluation technique.
QUALITY IMPROVEMENT IN NURSING EDUCATIONAL INSTITUTIONS

The quality of nursing education could be evaluated by many indicators such as standard
curriculum, number of qualified teachers, number of students passing the national examination, number
of students receiving a nursing license upon graduation, number of students getting jobs upon
graduation, a number of research grants and number of publications in peer review journals

Fig .15.3: Cycle of quality improvement in education

According to the WHO Work shop on 'Report of Regional Workshop' Male,

Maldives, 9-11 July 2007 participants presented strategies or methods used for quality
improvement in their educational institutions . These were:
• Standar ds for curriculum and educational institution
• Upgrading of student admission criteria, i.e. from grade 10 to grade 12.
• Recruitment of students by central examination.
• Curriculum revision.
• Upgrading of level of nursing education, i.e. from diploma to a degree
program.
• External committee to review the test or sit in on the fin al examination.
• Formal study for higher degree of teachers.
• Refresher courses for teachers.
• Nursing council offering comprehensive examination to all schools.

INC plays very important role in providing and maintenance of Quality education in Indi a.
The Indian Nursing Council (INC) prescribes the syllabus, including unit plan and hours of each
subject, scheme of examination and admission criteria. This ensures that the education offered in all
nursing institution s is uniform. Minimum standards are also se t for the physical facility, teaching
facility and clinical facility to start a nursing program. The Indian Nursing Council conducts yearly
or periodic inspections of the institutions.
 STANDARDS

DEFINITION OF STANDARD

Standard is an established rule as a basis of comparison in measuring or finding capacity, quality

context and value of objects in the same category standard as a broad statement of quality.

Standard is a predetermined baseline condition or level of excellence that comprises a model to be

followed and practiced. It is used as a measurement tool.

Standards are defined as authoritative statements that describe a common level of care
and performance by which the quality of practice can be determined or measured. Standard helps define
professional practice' (Huber, 1996).

Standards are conceptualized as the clear definition of a mode l, criterion, or rule of the minimum
acceptable requirements for the operation of specific processes, to ensure quality in the provision of
educational programs. The standards clearly state the expected behaviour and desired processes and are
used as guides to evaluate their performance and achieve continual improvement of services.

IMPORTANCE OF STANDARDS IN NURSING

It is an authoritative statement by which the quality of nursing practice, service and education can be
judged .
1n nursing practice, standards are the established criteria for the practice of nursing.

 It is a guideline for a recommended path to safe conduct, an aid to professional performance.

 It provides a baseline for evaluating quality of nursing care, increase effectiveness of care
and improve efficiency.
 Standards help supervisors to guide nursing staff to important performances.
 Standards may help to clarify nurses' area of accountability.
 Standard s may help nursing to clarify and de fine different level of care.
 Standard is a device for quality assurance and quality control.
 Standards give direction and provide guidelines for performance of nursing staff.
 Standards may help to improve documentation of nursing care provided in maintaining records of
care.
 Standards may help to determine the degree to which standard s of nursing care are
maintained and take necessary corrective action in time.
 Standards may help justify demands for resource association.

PURPOSES OF STANDARDS

The purpose of publishing, circulating, and enforcing nursing care standards are to:
• Improve the quality of nursing.
• Decrease the cost of nursing.
• Determine negligence.
 CHARACTERISTICS OF STANDARDS

 The statement must be broad enough to apply a wide variety of settings.

 Must be realistic, acceptable, and attainable.
 Nursing care must be developed by members of the nursing profession.
 Standards must be understandable and stated in unambiguous terms.
 Standards must be based on current knowledge and scientific practice.
 Standards must be reviewed and revised periodically.
 Standards must be directed towards an optimal standard.

SOURCES OF NURSING CARE STANDARD

The standard can be established, developed, and reviewed as enforced by variety of source s as
follows
• Professional organizations like TNAI.
• Licensing bodies INC, IMC, and DCI etc.
• Department of the institution, university, hospital, department of nursing.
• Patient care units, e.g., specific patient units.
• Government units at national, state and local government level.
• Individual, e.g., personal standard.

CLASSIFICATION OF STANDARDS

There are different types of standards used to direct and control nursing action.

 Normative: Normative standards describe practice considered good or ideal by some

authority group.
 Empirical: Standards describe practice actually ob- served in a large number of patient care
setting. Here the normative standard s describe a higher quality of performance than
empirical standards. ANA/TNAI promulgates normative standards, whereas law
enforcement and regulatory bodies (INC /MCS) promulgate empirical standards.
 Physical standard: This includes patient activity rating to establish nursing care hours per
patient per day.
 Cost standard: This includes the cost per patient/ day.
 Capital standard: This includes the review of monetary investments at new programs.
 Revenue standard: This includes the revenue per patient day for nursing care.
 Program standard: This guides the development and implementation of
programs to meet client needs.
 Intangible standards: Which include staff development and personnel orientation
cost.
 Goal standard: Which outlines qualitative goal in short and long term planning.

NURSING CARE STANDARD

• End standard: The end standards are patient oriented; they describe the changes as desired in a
patient's physical status or behavior. End standards require information about the patient.
• Mean standards: The mean standards are nursing oriented, they describe the activities and
behavior designed to achieve end standards. Mean standards call for information about the
 nurse's performance.
Nursing care standards can be classified according to frame of references, relating to nursing structure,
process and outcome. Standards can be established to app raise care, according to many approaches.
The most common approaches are based on structure, process and outcome. The nursing
organisation or structure is usually evaluated according to structure standards, the activities or
delivery of care are evaluated by process standards, and the patient's status is evaluated by
outcome standards.
• Structure standard: A structure standard involves the se t up of the institution. The philosophy,
goal, and objectives, structure of the organisation, facilities, equipment and qualification of
employee are some of the components of the structure of the organisation. Example:
recommended relationship, between the nursing department and other department in a
health agency are structural standard s, because they refer to the organisational structure in which
nursing is implemented. It includes people, money, equipment, staffing policies, etc. The use of
standards based on structure implies that if the structure is adequate, reliable and desirable,
standard s will be met as quality care will be given.
• Process standard: Process standards describe the behavior of the nurse at the desired development
of performance. A process standard involves the activities concerned with delivering patient
care. These standards measure nursing action or lack of actions involving patient care. The
standards are stated in action verbs that are observable and measurable terms. For example, the
patient demonstrates the focus is on what was planned, what was done, and what was
communicated and recorded. In process standard, there is an element of pro fess ion al judgment,
i.e., determining the quality as the degree of skill. It includes nursing care technique, procedures,
regiments, and process.
• Outcome standards: Descriptive statements of de sired patient care results are outcome standard,
because patients' results are outcome of nursing intervention. The outcome standard measures changes
in the patient health status. This change may be due to nursing care, medical care, or as a result of
variety of services offered to the patient. Outcome standards reflect the effectiveness and results rather
than process of giving c a r e .

Thus, structural standards are agency or group oriented, process standards are nurse oriented,
and outcome standards are patient oriented.

Frame of reference for evaluation of nursing care, structure, process and outcome

Focus of What to assess Information method Sources

Evaluation and tool
Structure Physical facilities. Observation Checklist  Nursing personnel.
Equipment and supplies. Questionnaire Review
 Nursing service unit.
Staffing-number qualification, of record. Interview
policies. Organisational Reports.  Physical plant
objectives, Organisational Documents.
 Management
characteristics, administrative
performance. Record,
policies financial resources.
Reports.
 Documents
Process The performance of the nursing Observation. Client / patient.
staff nursing technique, nursing Task analysis Client record.
procedures, nursing activity Activity studies. Nursing personnel
carried out Time studies
Adequacy of care, quality Questionnaire
Appropriateness of care Review of record and
 Quality of care and standards report and documents.
maintained Quality control check
list
Outcome End results or effectiveness of Observation. Client / patient.
the care given. Interview. Client record
Change in health status of client. Nursing audit.
Change in self care status of Review of
patient may • also include records.
factors that can influence Reports and
outcome, e.g., client satisfaction documents
The quality of the educational process is evaluated through ' Indicators. An indicator is a
characteristic or variable that can be measured. The construction of an indicia tor means to account
for a phenomenon in education, by absolute numbers, rates or more sophisticated indices. The
indicators are classified in to three indicators of structure, process and outcome. These indicators will:
a) Measure 'how well executed',
b) Develop evaluation criteria; c) Design a program of continuous improvement.
The objectives of using standard s and indicator s for the management of the nursing schools/colleges
are:
• Identify problem situations that are likely to be improved,
• Incorporate improvement cycles to solve the identified problems,
• Internal comparisons over time,
• Comparisons with other institutions.

ATTRIBUTES OF GOOD INDICATORS IN EDUCATION

• Be useful: Gives answer s and is designed for a specific purpose.

• Validity: Measures what it intends to measure.
• Reliability: The same results are reproduced if the measurement is repeated under similar
conditions.
• Specificity: Measures only the phenomenon being measured.
• Sensitivity: Measures the changes in the phenomenon being measured
• Measurability;: Based on data available or easy to obtain and easy to use. It is imperative
to collect a limited amount, but feasible and valid rather than trying to complicate the
indicator by systems impractical or complex parameters.
• Relevance: Able to give clear answers to relevant issues emedded in health policies.
• Cost Effectiveness: That that investment in time and other resources needed to construct
the indicator is justified by its use and results.
• Integrity: Means that the required data are complete.
• Internal Consistency: Refers that in the indicators, seen alone or in groups, the values are
consistent and sensitive to change.
• Transparency: Refer to be easily understood and interpreted by users.
• Dissemination: To be accessible to users through periodicals.
• Dynamism: To update and correct as far as the environment changes. This may change
in terms of the specific condition s described by indicators data availability, scientific
knowledge, or in levels of interest and needs of users.
Haruthai Ajpru, Shotiga Pasiphol, Suwimon Wongwanich, Thailand conducted a study for the
Development of an Instructional Quality Assurance Model in Nursing Science. Standard and Indicator for
instructional quality assurance in nursing science as published in Journ al, 'Research in Higher education
Journal.' are as follow.:
Standard and Indicator
Curriculum
 Planning of Curriculum
Administration and
 Curriculum
Implementation
 Evaluation and
Improvement
Learning Facilitating Factors
 Venue Promptness
 Facilitc1ting Factor
Administration
 Promptness of Learning
media
 Availability of facilities
and training venue
Criteria
 Appropriation of curriculum philosophy
 Appropriation of curriculum structure
 Availability of lesson plan
 Lesson progressed as plan
 Standard of the institute's curriculum for Bachelor of
Nursing Science
 Availability of system and mechanism for curriculum
evaluation and improvement
 Application of curriculum evaluation result in curriculum
improvement
 Adequacy of lecture building and
classroom
 Venue for extracurricular activity to enhance
student's development
 Safety and Hygiene of student's accommodation
 Sufficiency and promptness of nursing operation
room's equipments Sufficiency and promptness of
laboratory's equipments
 Sufficiency and promptness of computer room's equipments
 Planning for administration of instructional facilitating
factor.
 Compliance with administration plan for instructional
facilitating factor
 Evaluation of administration plan for instructional
facilitating factor
 Application of the result from evaluation of administration
plan
 Sufficiency and modernization of principal textbook for
nursing
 Sufficiency and modernization of journal for nursing
profession
 Availability of technological system for domestic and
International data/information.
 Sufficiency and availability of Audio visual media and
equipment.
 Sufficiency of Audio visual aids specialist
 Adequacy of library service time for self-learning
 Completion of training venue for all branches of instruction
 Availability of the system for nursing quality assurance
/control
 Availability of safety system to prevent and protect student
and client during training
  Instructor and instructor development
 Instructor development
 Quantity and Standard of certified and knowledgeable instructor
Qualification of
instructor
Teaching Schedule
 Lesson Plan
 Lesson Process
 Teaching Technique and
Learning Activity
 Assessment and
Improvement
Evaluation of Learning
Evaluation Plan
. 
Evaluation Process
Evaluation and Improvement
of instructional Evaluation
System
 Implementation of Instructor development system
 Availability of new instructors orientation system
 Adequacy of teaching task for instructor.
Adequate quantity of instructor for practical training

Compliance of the instructor to profession code of

conduct as an instructor
 Determination of objectives for each subject in the
curriculum
 Availability of mechanism to enable instructor's comprehension
on the curriculum
 Accordance between subject matter and subject's objective
 Availability of theoretical lesson plan
 Availability of practical lesson plan and clinical demonstration
 Planning of knowledge enhancing activity
 Availability of course syllabus for all practical and
theoretical subjects
 ..
Availability of sheet and lecture note for all subjects
 Availability of appropriate teaching material for learning
management .
 Availability of practical training for student's real experience
 Flexibility of various learning methods, corresponding to
learner's desire
 Participation of student in class
 Accordance between practical and theoretical learning
 Availability of audit and evaluation system for teaching
quality
 Availability of teaching quality evaluation by student
 Availability of teaching quality evaluation by instructor
 Development to modernize subject matter, corresponding
to society changes
 Development of learning innovation
Determination of behavioral objective for each subject matter
 Availability of decision system for quality learning
achievement
 Periodical Evaluation for learner development
 Availability of various learning evaluations
 Availability of system for quality examination and
examination paper
 Analysis of all subject's examination papers.
 Correspondence between examination papers and behavioral
objectives
 Conduction of Critique for all subjects' examination papers
 Conduction of Comprehensive examination prior graduation
  Implementation of evaluation result to subject's
development
Nursing Student / 
Graduate . .
Nursing Student  Student shall obtain satisfying learning achievement

.
Student shall graduate within determined term of curriculum
 Student shall obtain nursing practical skills
 The student shall possess professional morality and ethic
Nursing graduate  Nursing graduate shall securely get the job
 The result of professional registration examination shall meet
the standard
 System for pundit's quality monitoring and evaluation
 Commander/Superior shall be satisfied with pundit's work
operation
Quality assurance and quality improvement are processes that evaluate the quality of nursing care
delivered on a unit. Active participation ensures that relevant practice issues are monitored as they
influence client outcomes. Quality improvement activities provide opportunities for all healthcare
professionals to e leva te the level of care delivered do clien t.

ACCREDITATION
All professionals have one thing in common, that is concern for the quality of their service , w
hic h is ensured by developing and enforcing the standards. Two important ways of setting standards
are accreditation of the education program and the professional licensure. The program of action of the
nation al policy on education 1986, has proposed the establishment of an accreditation and assessment
council (ACC) for maintaining and raising the quality of the institution of higher education. The university
grants commission (UGC) has constituted a committee with Dr. Vasant Gowarker as the convener in
November 1986. Institutional accreditation originated in the USA.
Accreditation is a process of validation in which colleges, universities and other institutions of higher
learning are evaluated . The standards for accreditation are se t by a peer review board whose members
include faculty from various accredited colleges and universities. The board aids in the evaluation of each
potential new school accreditation or the renewals of previously accredited colleges/schools.

The accreditation of the college of Nursing is the result of a process of evaluation and systematic
monitoring and voluntary compliance of university functions, which allows getting accurate and
objective information on the quality of the academic unit evaluated. To certify the quality of tra ined
human resources and the various educational processes taking place in it. It is the formal an d public
recognition given to a nursing college that has made significant progress in fulfilling its mission and
stated goals, and meets an agreed set of criteria, indicators and standards of relevance and quality.

DEFINITION OF ACCREDITATION

According to Styles and Affara, 1997, Credentialing is a term applied to processes used to
designate that an individual, programme, institution or product have met established standards se t
by an agent (governmental or non-governmental) recognised as qualified to carry out this task. The
standards may be minimal and mandatory or above the minimum and voluntary. Licensure,
registration, accreditation, approval, certification, recognition or endorsement may be used to
describe different credentialing processes but this terminology is not applied consistently across
 different settings and countries. Credentials are marks or 'stamps' of quality and achievement
communicating to employers, payers, and consumers what to expect from a ' credentialed' nurse,
specialist, course or programme of study, institution of higher education, hospital or health
service, or healthcare product, technology, or de vice. Credentials may be periodically renewed
as a means of assuring continued quality and they may be withdrawn when standards of
competence or behavior are no longer met.
According to Selden (1962). 'Accreditation is the process whereby an organization or agency
recognizes a college or university or program of study as having me certain-predetermined
qualifications or standards '

Accordingly to UNESCO

Accreditation is the process by which a (non) governmental or private body evaluates the
quality of a higher education institution as a whole or of a specific educational program me in
order to formally recognize it as having met certain predetermined minimal criteria or
standards. The result of this process is usually the awarding of a status (a yes/ no decision), of
recognition, and sometimes of a license to operate within a time limited validity. The process
can imply initial and periodic self-stud y and evaluation by external peers.'
The accreditation system is defined as a set of policies, strategies, processes and organizations
whose main objective is to guarantee to society that higher education institutions are par t. of the
national system that meets the highest standards of quality and the training of professionals.

PURPOSES OF ACCREDITATION

The goal of accreditation is to ensure that education provided by institutions of higher

education meets acceptable levels of quality. The major purpose s of accreditation includes:
• -For the maintenance of adequate administration requirement.
• To evaluate the success of a nursing program in achieving its mission, goals, and outcomes.
• .,To assess the extent to which a nursing program meets accreditation standards.
• To inform the public of the purposes and values of accreditation and to identify nursing
programs that meet accreditation standards.
• To foster continuing improvement in nursing
• programs-and, thereby, in professional practice. Maintaining a uniform standard for
nursing education and nursing service.
• Promoting competent practices and protecting the public from unsafe practices by
agreeing upon standards that are congruent with the knowledge, skills and behaviors
required for qualified practice;
Fostering the nursing profession by setting and enforcing measurable standards for
education nationwide which contribute to promoting the profession's development, identity
and status;
• Assuring the quality of the institution or program;
• Assisting in the improvement of the institution or program.
• Stimulation of institutional self-improvement by evaluation and inspection.
• It safeguards the institution from social education and political pressures.
• It helps in the registration of nurses.
• It prescribes the syllabus.
• It grants recognition to schools and colleges.
• It guides the school/college of nursing, according to recommendation and criteria.
also services to prepare the competent to serve the public.
•• To ensure safe practice of nursing by setting standards for schools and colleges preparing
 the professional s .
· • T o e n courage study and self-evaluation within the educational units for the
development and improvement of the educational program.
• To ensure maximum benefit for the students and to protect the students' interests.
• To ensure the graduates of the accredited schools the eligibility for ad mission to the
licensing examinations.
• It acts as a monitoring and controlling agency
• To provide a list of accredited schools of nursing and this assist students and counselors
in selection of schools, which offer accredited programs in nursing?

FUNCTIONS OF ACCREDITATION

 It aims to protect the autonomy of various health service programs. For example,
nursing education and medical education.
 It preserves the quality of nursing education.
 It protects the public from ill prepare d nurses.
 It protects the institutions unsound and unsafe political pressure.
 It helps the practitioner for the broad scope of nursing practice.

TYPES OF ACCREDITATION AGENCIES

Regional Accreditation Agencies

Regional agencies are concerned with as institution as a whole. They are general in nature.
They are concerned with appraising the total of the institution of higher learning and with
safeguarding the quality of education and foundation of professional programs in colleges and
universities. Each agency establishes criteria for the evaluation of institution in its region. It
receives those institutions periodically and publishes from time to time a list of those
institution which it has accreditated.
Profess ion al accrediting agencies

Professional accrediting agencies are specialized and each is concerned with particular
profession.

State accrediting agencies

Accreditation in certain stages may be the function of state agencies. It assumes the
responsibility mainly for teacher education. State universities commissions and other
 agency are authorized in some state to evaluate college, to give initial approval to
institutions to higher learning to formulate standards, to issue licenses and to have
various other responsibilities. Many state agencies accept the accreditation of regional and
national accrediting agency as a basis for their approval of the institutions.
National accrediting agencies

In 1904 started with the accreditation of medical school. Membership in some agencies
composed number of some combination of nurses and doctors (See Table).
National Commission of Accreditation

As the number of accreditation agencies were established to control the activities of

accreditation agency.
Functions of national commission of accreditation

• To study and investigate the accreditation agency.

• Publish a t of accreditating agencies, it has val.
• To collect and publish information on higher education, that is pertinent to
accreditation.
Regulatory and Statutory Bodies in Higher Education

S.No Name of the Body Mandate

University Grants
Commission
All India Council for
Technical Education
 Coordination, determination and maintenance of standards in
higher education.
 Release of grants to individual institutions
 Proper planning and coordinated development of technical
education system throughout the country.

Distance Education  Promotion of Open University and Distance Education

Council
Indian Council of
Agricultural Research
Bar Coucil of India
National Council for
Teacher
systems in the educational pattern of the country and for
coordination and determination of standards of teaching,
evaluation and research in such systems.
 Coordination of agricultural research and development
programs and develop linkages at national and international
levels with related organisations to enhance the quality of life
of the farming community
 Coordination, determination and maintenance of standards in
legal education and profession.
 Achieving planned and coordinated development of the
teacher education system throughout the country, the
regulation and proper maintenance of norms and standards in
teacher education on and for matters connected therewith

IMPORTANT FEATURES OF THE ACCREDITATION PROGRAM:

The accreditation and the assessment council is pro- posed as a voluntary body of member
institutions.
There are two categories of accreditation - institutional of professional. The important
concern of the accreditation and assessment council is to develop an institutional accreditation
mechanism. Institutional accreditation is a means for the self-regulation of the academic
institution.
 Institutional accreditation is done in two parts. The first part starts with self-study by the
institution, involving various activities including faculty, students and the institutional management.
The second part of the institutional accreditation process involves an outside evaluation by a team of
professional educators constituted independently by the accrediting agency. The institutional
accreditation process involves the judgment of the responsible members of the profession to see
whether the institutional goals conceived are appropriate, i.e. the educational program is intelligently
planned and competently conducted. The institution fulfilling the professional goals and having adequate
resources run the program for imparting quality education.
In order to be accredited an institution must fulfill the criteria set by the accrediting agency. The
institution will be assessed in each of the principle areas as given below for the institutional functioning
and responsibility.
• Institutional mission and objectives.
• Evaluation and planning
• Organization and governance
• Program instruction
• Special activities
• Faculty
• Student services
• Library and learning resources
• Physical resources
• Financial resources
• Advertising and publication

POLICIES FOR ACCREDITATION

Board approval of the initial development of the nursing program includes following steps:
• Letter of intention should be submitted to the board describing the reasons for establishing the school
and the predicted timetable of development.
• Qualification forms to be submitted to the board, by the full time person responsible for the
program, who is qualified registered nurse with the master degree in nursing. Faculty
qualification performs as should be attached.
• Nu rse director or chairman of the department nursing should be employed on a full
time basis for one academic year before the admission of student
• to the nursing program. This period is known as the 'planning year'. There should be
funds available for the departure chairman to have nurse faculty members participate
in developing the philosophy , objectives and course content in the nursing subjects
prior to their full appointment of the faculty.

Board approval for the admission of students

• A statement describing the philosophy, objectives, nature of organization and

administration should be submitted to the board, at least three weeks prior to the
board meeting at which time the program will b e re viewed. This must occur at least
6 months to the admission of the first batch.
• The statement should contain descriptions of the following as well:
• Student body (number to be admitted to the first batch maximum number to be
admitted with a projected time table containing source of qualified students desiring
this type program). Faculty: Number to be employed, dates of appointment, criteria
for faculty recruitment, qualification of appointed members.
• Note: Not more than 10 students should be the responsibility one faculty member
in a clinical area at any one time.
• Curriculum, educational and clinical facilities Projected budget for a five year period
• Plans for evaluation.
Further Procedures regarding Board Approval
• An application for accreditation should be filled by concerned authorities.
 • The request will be reviewed at regular board meeting.
• Initial accreditation is granted for a period of one year, after which time an evaluation
visit is made, the evaluation determined on the basis of the total program in relation
to the stated purposes an d the degree to which these have been achieved.
• Renewal accreditation is based on survey visits, Conference and correspondence during the
period, the annual report etc.

PROCESS OF ACCREDITATION
The regional consultation on accreditation guidelines for educational/training institutions and
programs in public health was organized in Chennai, India in 2002. It concluded that:
 Public health institutions must have a mission statement and objectives. It must prescribe the
educational process required to produce profess ion al and stud en t competencies.

Applying for the institution to be accredited

Preparing a report by the institutional head according to the criteria and format sent by
the accrediting agency

Visit to the site by the inspectors appoint by the accrediting agency to verify the
self study report

Preparing a report by the visitors

Preparing a report by the visitors along with the institutional report is sent to the
review board of council

The board of review on the basis of all data and reports make the final decisions
whether accreditation should be granted or not

The accreditation process generally involves three specific steps:

A self-e valuation process conducted by the faculty, the administrators, and the staff of the institution
or academic program me, resulting in a report that takes as its reference the set of standards and criteria
of the accrediting body;

1. A study visit, conducted by a team of peer s, selected by the accrediting organization,

which reviews the evidence, visits the premises, and interviews the academic and
administrative staff, resulting in an assessment report, including a recommendation to
the commission of the accrediting body;
2. An examination by the commission of the evidence and recommendation on the basis
of the given set of criteria concerning the quality and resulting in a judgment and
 the communication of the formal decision to the institution and other constituencies,
if appropriate (Fig. 15.4).
Criteria for accreditation:
The report of the inspection of the college includes:
• Type of training given
• Date of previous inspection
• Recognition of the college by the government order no., date and no. of seats
sanctioned for the year.
• Number of the student s admitted for the year after the last date of inspection and
regarding the detail of staff qualification.
• Registration no, registration valid
• Non-nursing teachers and other staff members
• Physical facilities available in the school, no. of classrooms, Demonstration room, Library,
Office of principal, tutors, L a b o r a t o r y .

Fig. 15.4: Process of accreditation

Process of Registration of School/Colleges Trial basis: recognition given on the temporary basis is
based on the application submitted plus pending inspection and is don e after the favourable report of
accreditation.

Permanent recognition: after the inspection and evaluation that is when the school / college meet all the
criteria prescribed by the INC permanent recognition is given.
Services rendered by accredited agencies:

• Registration and admission of students. Accredited institutions are also expected to counsel
students as to assist them in proper selection of the subjects.
• Distribution of stud y materials
• Organization of person al contact program and registering students for extern al
 examination.
• Distribution of marks sheets and certificates.
The school and colleges are expected to keep ready the follow in g :

General information

• The name of the university it is affiliated.

• Date of establishment of program
• Date recognition by state nursing council, INC or university
• Number of students graduating per year
Philosophy: Aims and objectives of the institution and departments

Organization and administration

• Organization chart of institution and colleges

• Placement of principal
• Line of authority
• Teaching staff and non-teaching staff

Teaching staff

• Internal lecturers
• External lecturers
• Staff selection procedures
• Staff development program
• Seminars attended

Administration and physical setup

• Office and room for principal

• Staff, clinical staff, number of classrooms, all labs such as nursing foundation lab, nutrition
lab, community lab, etc.
• Hostel, cafeteria, dining hall, reading hall, toilet facility, etc.
• Number of books, periodical
Finance

• Total budge t sanctioned

• Drawing offices- separate and combined
Committees

• Advisory committee, development committee, student welfare committee

Staff teaching monitoring technique

Construction and institution facilities

• Syllabus, prospectus, application forms, bond paper, etc.

Health facilities for students and staff

• Medical checkup
 Clinical set-up

• Community experience, family people co-curricular activities

• Research of students, application forms and bond paper signed
• Attendance registers, practical record, leave record
• Evaluation form, master plan, examination results and assignments
• Drug study, lesson plans, nursing care plans and clinical presentation.

ACCREDITING AGENCIES- ICN, INC, PNRC AND UNIVERSITIES

INTERNATIONAL COUNCIL OF NURSES (ICN)

The International Council of Nurses was founded in 1899 by Mrs. Bedford Fenwick. It is a
federation of non political and self governing national nurses association. ICN is Non
Partisan body, i.e. not controlled or influenced by, or supporting, any single political party.
The headquarters is in Geneva, Switzerland. The Council of National Nursing Association
Representatives (C R) is the governing body of ICN.

PURPOSES OF ICN:

• The purpose of ICN is to represent nurses worldwide and to be the voice of nursing
internationally.
• To provide a means through which the national associations can share their interests in the
promotion of health and care of the sick.
• Great emphasis has been placed upon non discrimination.

OBJECTIVES OF ICN:

• To influence nursing, health and social policy, professional and socio- economic
standards world- wide.
• To promote the development of the strong National Nurses Association.
• To assist the national nurses association to improve the standard of nursing and the
competence of nurses.
• To assist the national nurses association to improve the state nurses within their countries.
• To serve as the authoritative voice for nurses and nursing internationally.
• To establish, receive and manage funds and trusts which contribute to the advancement
of nursing and of ICN .
Role of ICN
ICN provides a range of credentialing services and products. These include
• Publications including standards, competencies and guidelines;
• Approval of educational activities for the award of continuing education credits;
• Consultancy and advice to individuals, groups, organizations and governments;
• Advocacy at international and global level; and
• Opportunities for interaction amongst interested parties through meetings, conferences
and web based activities.
Members of ICN

There are currently four categories of membership:

 i. Alliance: Under this category, national nursing groups in the country decide to form a new
national nursing organisation for international purposes. Ban de d together in an
international alliance, the Alliance becomes the full ICN member. The Alliance determines its
own makeup and may include national generalist and specialist groups.
ii. Associate: Under this category, three national nursing organizations can be ICN members.
The most representative NNA is the full ICN member and retains full membership rights and
obligations. Two (2) other national nursing associations, with the support of the NNA, may
become associates of ICN Associates have restricted membership rights and obligations.
iii. Collabrational : Under this category, there is one full ICN member with the associated
rights and responsibilities. However, it speaks from the informed perspective of the input
of the selected national nursing collaborating groups. The full NNA member selects
national generalist and specialist groups with whom it wishes to collaborate on
international issues and establishes national operating rules for doing so. The full ICN
member seeks input from the collaborating organisations prior to forming its position
on international issues.
iv. Traditional: Under this category there is norm ally only one full NNA per country
and this is the most representative generalist nursing organisation in the country. In
the case where the association represents less than 6% of nurses in the country
additional full ICN members, that complies with the requirements of size* and also
comply with the requirement s for a National Nurses' Association*, may also
join.

INDIAN NURSING COUNCIL

The Nursing Council Act came into existence in 1948 to constitute a council who would
safeguard the quality of nursing education in the country. The mandate was to establish and
maintain uniform standards of nursing education. Nowadays, the Indian Nursing Council is a
statutory body that regulates nursing education in the country through inspection, examination,
certification and maintaining standard of nursing India.
India n nursing council is considered to be the statutory body that influences nursing
education at the nation al level. The INC is an autonomous body under the Government
of India, Ministry of Health and Family Welfare. Indian Nursing Council act, 1947 was
constituted to establish a uniform standard of education for nurses, midwives, health
visitors and auxiliary nurses. The Indian nursing council act was enacted in 1947.
Composition and constitution: the Indian nursing council consists of the following
members:
• Elected members - 25
• Nominated member - 4
• Ex-officio members - 33
Elected members - 25

• Nurses from state council

• Heads of institutions giving training for degree. Nursing and certificate courses - 2
• Head of an institution training health visitors - 1
• Medical Council of India - 1 ·
• Central Council of Indian Medical Association - 1
• TNAl-1
• State Nursing Councils (ANMs)- 3
• Parliament - 3
• Nominated member s - 4
• Government of India nominee
Ex-officio members - 33

• Director General of The Health Sciences -1

iv. The Chief Principal/Matron - 1
• The Chief Nursing Superintendents
• The Director of Maternal And Child Welfare
• The Chief Administration Medical Officers of Each State
• Superintendent of Nursing Services
COMPOSITION: Nurses - 30, doctors - 24

The president shall be elected by the members of the council among themselves. Members of the
council are elected by the state council
Philosophy

INC, states that, nursing is the unique function of the nurse, that is, to assist the individual, sick or
well, in the performance of those activities contributing to health or recovery, that he would
perform unaided if he had the necessary strength, will or knowledge. Keeping this in mind, the
nursing is a formal educational preparation, which should be based on sound educational
principles. It recognizes the programs as the foundation on which the practice of nursing is built
and on which depend s further professional education. It recognizes its responsibility to the
society for the continued development of students as individuals, nurses and citizens. The INC
recognizes the necessary of developing a deep pride in the nursing profess ion among student s to
enable to further profess ion among the students and to enable further professional growth.
AIMS AND OBJECTIVES OF INC

• To regulate the training policies and programs in the field of nursing.

• To bring about standardization of training courses.
• To regulate these standard s in all training institutions uniformly throughout the country.
• To recognize institutions imparting nursing education at various diplomas, graduate and post-
graduation levels.
• To promote research in nursing education.
• To maintain Indian nurses register for registration of nursing personnel’s.
• To establish a uniform standard of training throughout the state
• Prohibit training centre, which are inadequate
• Prohibit the practice of nursing by non-qualified nurses.
FUNCTIONS AND ROLE OF INC

The INC provides a framework for nursing in India. It has many roles:
1. Prescribing of syllabi: INC is prescribing syllabi and curriculum
for various courses in nursing and
Conducting the qualifying examination based on the development in science and technology.
Syllabi have also been prescribed for all post certificate courses, degree courses, and diploma and
for health visitor cour ses.
2. Inspection: Inspections are done and granting of recognition based as the requirement s, their set
up and the strength of the institution s. The y also have full freedom to withdraw recognitions. A
right of appeal against any disciplinary action is taken by the council.
NATURE OF INSPECTIONS BY INC

There are three types of inspections by INC since 1996.

1. First inspections
Institutions are inspected by the INC when they apply to start a course in nursing. This is the
 first step towards INC recognition. The schools that seek recognition are required to submit:
Permission letter from state government Permission letter from state nursing councils
A copy of the inspection report of the state nursing council
2. Re-inspections: These are done for those institutions which are found unsuitable on first or
subsequent inspection by INC. Once the institution takes necessary steps to remove the
deficiencies and informs the INC's re-inspection is done within one year or earlier.
Periodic inspections: Once an institution is give recognition by INC the institute is required
to send an annual inspection fee regularly. The INC inspects the institute generally after 3
years.

Process of Inspection by INC

The National Assessment and Accreditation Council (NAAC)

The National Assessment and Accreditation Council (NAAC) is an autonomous body

established by the University Grants Commission (UGC) of India to assess and accredit
institutions of higher education in the country. It is an outcome of the recommendations of the
national policy in education (1986) which laid special emphasis on upholding the quality of
higher education in India. To address the issues of quality, The National Policy on Education
(1986) and the plan of action (poa- 1992) advocated the establishment of an independent
national accreditation body. Consequently, the NAAC was established in 1994 with its
headquarters in Ban galore.
The vision of NAAC is to make quality the defining element of higher education in
India through a combination of self and external quality evaluation, promotion and
sustenance initiatives.
Mission
 • To arrange for periodic assessment and accreditation of institutions of higher education
or units thereof, or specific academic programs or projects;
• To stimulate the academic environment for the promotion of quality of teaching-
learning and research in higher education institutions;
• To encourage self-evaluation, accountability, autonomy and innovations in higher
education;
• To undertake quality-related research studies, consultancy and training programs, and
• To collaborate with other stakeholders of higher education for quality evaluation,
promotion and sustenance.
Guided by its vision and striving to achieve its mission , the NAAC primarily assesses the
quality of institutions of higher education that volunteer for the process, through an
internationally accepted methodology.

Trained Nurses Association of India (TNAI)

It is a national profess ion al association of nurses. The TNAI had its beginning in the
Association of Nursing Superintendent, which was founded in Lucknow in 1905.

Purposes of TNAI

• Upholding the dignity and honour of the nursing profession.

• Promoting a sense of esprit de corps among all nurses.
• Enabling members to take council together onMatters relating to their profession

AIMS OF TNAI

• It focuses on upgrading, development an standardization of nursing.

• It aims to improve the living and working conditions for nurses in India, and
registration for qualified nurses.
ACTIVITIES OF TNAI

• It has promoted the development of courses higher education for nurses.

• T Al grants scholarship for nurses , who wish to go for higher advanced studies in
India or Abroad.
• It helped to remove discrimination against male nurses.
• It organizes and funds various workshops, seminars and conferences, both at state
and national level.

BABA FARID UNIVERSITY OF HEALTH SCIENCES, FARIDKOT

Baba Farid University of Health Sciences was established under an act passed by the
legislature of the state of Punjab in July, 1998. It was established in the memory of Great Sufi
Saint Baba Farid. The mission of the university is to create an intellectual, academic and
physical environment, conducive to the free flow of ideas and exchange of information
between various faculties of the university and between this university and other
universities of health sciences in the country and abroad, thereby opening a window to the
world for the health professionals, health planners, health managers, biomedical and social
scientists and educators in health sciences of the country.

No. of Affiliated Colleges

 Medical 8
Dental 14
Ayurvedic 12
Nursing 78
Physiotherapy 11
Homeopathic 4
Sports Medicine 1
Med. Lab. Technology 5
B.Sc (Medical) 3
The university has six faculties, namely faculty of medical sciences, faculty of dental sciences, faculty
of nursing sciences, faculty of ayurveda, faculty of physiotherapy and faculty of homoeopathy
Hisexcellency, the Governor of Pun jab has recognized all the degrees and diplomas certificates and other
academic distinctions awarded by the this university w.e.f. 1st July, 1999.

The Govt. of India has recognized the M.B.B.S, M.D MS/ PG diploma/BDS/B.Sc.(nursing)/M.Sc.(nursing)
being awarded by B.F.U.H.S

PUNJAB NURSES REGISTRATION COUNCIL (PNRC)

PNRC stands for Punjab Nurses Registration Council. The Punjab Nurse Registration Act has been
made in 1932, on the provisions of the English and Madras Acts. It was first published in the Punjab
Gazette, Extraordinary, of the 7th June,1932.This act was passed to provide registration and better
training to Nurses, Health Visitors, Midwives and dais in Punjab.

According to the Punjab Nurse Registration Act, 1932, The Council shall consist of the following
members, namely:

a. The Director of Health Services, Punjab;

b. Eight members to be appointed by the State Government from among the persons specified in
the Schedule, four of whom shall be Nursing Superintendents of. the hospitals training candid ates
for any of the examinations conducted by the Council;
c. Two registered nurses to be elected by the nurses, registered under the Act;
d. One registered health visitor to be elected by the health visitors registered under the Act;
e. One registered midwife to be elected by the midwives, registered under the Act, provided that, should
the registered nurses or the registered health visitors or the registered midwives fail after the
occurrence of a vacancy to elect a member within such period as the State Government may by
rule prescribe, the State Government may fill such vacancy by the appointment of a registered nurse,
registered health visitor or registered midwife, as the case may be.
f. The appointment and election of members shall be notified by the State Government.
The Council shall appoint A Registrar who shall also act as treasurer, unless the Council appoints
ano ther person as treasurer, and may appoint such other officers or servants as it may deem necessary
and every person so appointed shall, subject to the rules, be removable from office at the pleasure of
the Council and shall be deemed to be a public servant within the meaning of section 21 of the Indian
Pena l Code.
Functions and Responsibilities of PNRC

• To protect the interests and rights of increasing numbers of trained nurses, health visitors,
midwives, nurse, dais and trained dais and of their clientele.
• To improve the professionals standards as registration in itself supplied an incentive to take
nursing as a profession.
• To prescribe the courses of training of, and qualification for the registration of, nurses, health visitors,
mid wives and ANMs
• To provide for the recognition of institutions competent to give nursing trainings.
• To regulate the issue of certificates, the maintenance of registers and the conditions of admission of
names of persons to such registers and to prescribe the form of application for such admission and
the uniform or badge to be worn by registered nurses, registered midwives, ANMs while on duty;
• To prescribe the fees for registration and there-entry of names removed from the registers;
• To regulate the publication of lists of registered nurses, registered health visitors, registered
midwives, registered nurse, ANMs ;
• To regulate the conduct of an d prescribe fees for examination of nurses, health-visitors, mid
wives, nurse-dais, auxiliary nurses
• To confer, grant or issue diplomas, licenses, certificates or other documents stating or implying
that the holder, grantee or recipient thereof is qualified to practice or otherwise work as nurse,
mid wife, auxiliary nurse and midwife, health visitor.
• To prescribe fees for the affiliation of institutions Recognized as training schools for nurses,
midwives, auxiliary nurses
• To prescribe the scale of fees, remuneration and travelling allowance to Examiners, Supervisors,
Invigilators and other persons appointed by the Council for the conduct of examinations;
According to Punjab Nurses Registration Amendment Act, 2006

• The council shall ensure that every nursing educational institution in the state maintains its
website, giving clear information about the availability of the prescribed infrastructure, names and
photographs of all faculty members, audited annual accounts, affiliation status, prescribed fees
and dues of all types, names of hospitals attached to clinical training and distance of such hospitals
from the institution. Every such website shall have a link to the official website o f the council.
• The council shall display all proceedings of it s meeting on its official website for information of the
general public.

• To improve the professiona ls standards as registration in itself s upplied an incentive to take

nursing as a profe ss ion.
• To prescribe the courses of training of, a nd qualification for the registration of, nurses, health visitors,
mid w ives and ANMs
• To provide for the recognition of institu tions competent to give nursing trainings.
• To regulate the issue of cer tificates, the maintenance of registers and the conditions of admission of
names of persons to such registers and to prescribe the form of application for such admission and
the uniform or badge to be worn by registered nurses, registered midwives,ANMs while on duty;
• To prescribe the fees for registration and there-entry of names removed from the registers;
• To regulate the p ublication of lists of registered nurses, registered health visitors, registered
 midwives, registered nurse, ANMs ;
• To regulate the conduct of an d prescribe fees for examination of nurses, health-visitors, mid
wives, nurse-dais, auxiliary nurses
• To confer, grant or issue diplomas, licenses, certificates or other documents stating or implying
that the holder, grantee or recipient thereof is qualified to practice or otherwise work as nurse,
mid wife, auxiliary nurse and midwife, health visitor.
• To prescribe fees for the affiliation of institutions recognised as training schools for nurses,
midwives, auxiliary nurses
• To prescribe the scale of fees, remuneration and travelling allowance to Examiners, Supervisors,
Invigilators and other persons appointed by the Council for the conduct of examinations;
ACCORDING TO PUNJAB NURSES REGISTRATION AMENDMENT ACT, 2006

• The council shall ensure that every nursing educational institution in the state maintains its
website, giving clear information about the availability of the prescribed infrastructure, names and
photographs of all faculty members, audited annual accounts, affiliation status, prescribed fees
and dues of all types, names of hospitals attached to clinical training and distance of such hospitals
from the institution. Every such website shall have a link to the official website o f the council.
• The council shall display all proceedings of it s meeting on its official website for information of the
general public.

BIBLIOGRAPHY

1. B.T. Basavanthappa, 'Text book of nursing administration', 2002, 1st edition, Jaypee Publications, pp439-442.
2. Barbara Kozier, ' Fundamental of nursing', 2002, 1st edition, pp323-324.
3. Cecilia Latra ch, Naldy Febre and Ingrid Demandes (2012.). Quality Assurance in the Career of Nursing, Quality
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19. NAAC. Quality Assurance in Higher Education An Introduction .June 2006 Bangalore: NAAC.
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